Fecal incontinence is the inability to control feces. The etiology of fecal incontinence is quite varied. Women who have experienced injury to the anal canal during childbirth commonly develop fecal incontinence. The anal muscles may be initially injured during childbirth but be competent for years. As time progresses, degeneration of these muscles may occur with significant decrease in the muscle strength and the development of fecal incontinence.
Women who have had multiple pregnancies, large birth weight babies, forceps deliveries and episiotomies may have an increased risk of fecal incontinence associated with anal canal trauma. Nerve injuries (pudendal nerves) may also cause fecal incontinence. This may occur with childbirth but other metabolic etiologies may cause nerve damage resulting in fecal incontinence. Infections, anal surgery and diarrhea may all be associated with fecal incontinence.
In order to assess the exact etiology, a complete exam is warranted. This usually includes a history and physical, appropriate medical tests and possibly endoscopy. Further tests which help identify the etiology of fecal incontinence include:
1. Defecography
2. Pudendal nerve studies
3. Anal manometry
Thus, the history of childbirth, sexual history, history of anal infections and sexually transmitted diseases as well as overall general medical condition are important in assessing the etiology of fecal incontinence.
Treatment of fecal incontinence is initially addressed with dietary changes. Most physicians recommend an increase in the amount of dietary fiber. Administration of antidiarrheal agents may also be helpful. Anal canal exercises may be very helpful in the treatment of fecal incontinence.
Some patients respond to biofeedback. Biofeedback allows patients to relearn the sensations associated with evacuation. In addition, more specific exercises which can improve anal canal function can also be taught.
If a patient has inflammatory bowel disease involving the rectum, this needs to be treated first before any further intervention.
Newer surgical techniques are now available which can assist patients with fecal incontinence. Some patients can undergo a surgical repair, sphincteroplasty, with excellent long-term results. This type of interaction should be carefully discussed with a colorectal surgeon or surgeon who has been trained, or has significant experience, in the performance of these procedures.
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Crohn's Disease |
Colon Cancer |
Colon Polyps |
Colorectal Cancer Screening Guidelines for 2001 |
Constipation |
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Diverticulosis |
Esophageal Strictures |
Fecal Incontenence |
Gastrointestinal Bleeding |
GERD Treatment Guidelines Summary |
Helicobacter Pylori |
Hemorrhoids |
Irritable Bowel Syndrome |
Lactose Intolerance |
Malabsorption Syndromes |
Pancreatic Cancer |
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Pilonidal Cysts |
Puritis Ani |
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Rectal Prolapse |
Treatment of Anal Fissures |
Ulcerative Colitis |
Whipple's Disease
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